Accessibility and affordability of drugs for common pregnancy complications in LMICs

Background: WHO guidelines include a comprehensive set of commodities, including medicines that are effective in preventing or reducing maternal and neonatal morbidity and mortality. However, there are challenges for implementing these medicines, particularly in limited-resource settings. This leads to variable coverage, and contributes to otherwise preventable harm, including maternal and newborn mortality. For example, magnesium sulfate is a life-saving medicine for preventing eclampsia, however it’s widespread use is hindered by significant barriers including system-level unavailability and high retail price compared to family incomes.1 There is currently no comprehensive assessment of the accessibility and affordability of drugs recommended in the WHO guidelines from pregnancy related complications. Methods: A complete list of medicines recommended for antenatal, intrapartum and post-partum women will be compiled from WHO recommendations. A systematic review including studies that report on the availability, price and affordability of these drugs, using the WHO/Health Action International methodology will be conducted. The WHO Essential Drugs and Medicine Policy Department and Health Action International (HAI) provides a standardized approach for countries to collect and analyze medicine price, availability, and affordability data across healthcare sectors, which are published on a globally accessible website (https://haiweb.org/what-we-do/price-availability-affordability/price-availability-data/). Availability is reported as the percentage of facilities in which a particular medicine was available at the time of the survey, price is reported in US$ and affordability is reported as the cost to patients in the public and private sectors. The systematic review will follow PRISMA guidelines. Data will be reported descriptively by country and by WHO global regions. Expected outcomes: This study will provide a comprehensive assessment of the availability, price and affordability of critical medicines to prevent maternal and newborn morbidity and mortality. It will allow comparisons between countries and identify knowledge gaps in the accessibility of maternal medicines.